Evaluation in the health sector: a conceptual framework

The practice of evaluation has existed in one form or another for as long a s one can remember and is central to all processes of learning. Today, eval uation is a popular concept grouping together multiple and diverse realitie s. This article aims to propose a conceptual framework for evaluation that is broad and universal enough to allow all those concerned with evaluation of health services (regardless of their disciplines and interests) to bette r understand each other, to perform better evaluations, and to use them in a more pertinent manner. We will begin by defining evaluation as the process which consists of makin g a judgement on the value of an intervention by implementing a system whic h can provide scientifically valid and socially legitimate information on r egarding this particular intervention (or any of its components) to the dif ferent stakeholders concerned such that they can form an opinion from their perspective on the intervention and reach a judgement which can translate into action. We define "intervention" as any organized system of action (a structure, ac tors and their practices, processes of action, one or many finalities and a n environment) aiming to, in a given environment, during a given time perio d, modify the foreseeable course of a phenomenon to correct a problematic s ituation. An intervention can be a technique, a medication, a treatment, an organisation, a program, a policy or even a complex system like the health care system. Various interventions, regardless of their nature, can be the object of two types of evaluation. Normative evaluation is based on appreciation of each component of the intervention according to criteria and standards. This ty pe of evaluation is defined as an activity which consists of making a judge ment regarding an intervention by comparing the resources utilized and thei r organisation (structure); services and goods produced (process) and resul ts obtained to criteria and standards tin other words, summaries of what is good and right). Did the intervention correspond to what should have been done according to the standards utilized? Evaluative research aims to employ valid scientific methods to analyze rela tionships between different components of an intervention. More specificall y, evaluation research can be classified into six types of analysis, which employ different research strategies. Strategic analysis allows appreciatio n of the pertinence of an intervention; logical analysis, the soundness of the theoretical and operational bases of the intervention; productivity ana lysis, the technical efficiency with which resources are mobilized to produ ce goods or services; analysis of effects, effectiveness of goods and servi ces in producing results; efficiency analysis, relations between the costs of the resources (or the services) used and the results; implementation ana lysis, appreciation of interactions between the process of the intervention and the context of implementation in the production of effects The official finalities of all evaluation processes are of four types: (1) strategic, to aid the planning and development of an intervention, (2) form ative, to supply information to improve an intervention in progress, (3) su mmative, to determine the effects of an intervention (to decide if it shoul d be maintained, transformed or suspended), (4) fundamental, to contribute to the advancement of empirical and theoretical knowledge regarding the int ervention. In addition, experience acquired in the field of evaluation suggests that e valuation is also productive in that it allows actors, in an organized sett ing, to reconsider the links between the objectives given, practices develo ped and their context of action. This task of achieving coherence is contin uous and is one of the intrinsic conditions of action in an organized setti ng. In this perspective, evaluation can have a kev role, given that it is n ot employed to legitimize new forms of control but rather to favor debate a nd the emergence of new practices.